<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

<!--    <div class="form-group">-->
<!--        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>-->
<!--        <div class="col-xs-12 col-sm-8">-->
<!--            <input id="c-name" data-rule="required" class="form-control" name="row[name]" type="text" value="{$row.name|htmlentities}">-->
<!--        </div>-->
<!--    </div>-->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Contact_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-contact_name" data-rule="required" class="form-control" name="row[contact_name]" type="text" value="{$row.contact_name|htmlentities}">
        </div>
    </div>
<!--    <div class="form-group">-->
<!--        <label class="control-label col-xs-12 col-sm-2">{:__('Wxapp_image')}:</label>-->
<!--        <div class="col-xs-12 col-sm-8">-->
<!--            <div class="input-group">-->
<!--                <input id="c-wxapp_image" class="form-control" size="50" name="row[wxapp_image]" type="text" value="{$row.wxapp_image|htmlentities}">-->
<!--                <div class="input-group-addon no-border no-padding">-->
<!--                    <span><button type="button" id="faupload-wxapp_image" class="btn btn-danger faupload" data-input-id="c-wxapp_image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-wxapp_image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>-->
<!--                    <span><button type="button" id="fachoose-wxapp_image" class="btn btn-primary fachoose" data-input-id="c-wxapp_image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>-->
<!--                </div>-->
<!--                <span class="msg-box n-right" for="c-wxapp_image"></span>-->
<!--            </div>-->
<!--            <ul class="row list-inline faupload-preview" id="p-wxapp_image"></ul>-->
<!--        </div>-->
<!--    </div>-->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Contact_phone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-contact_phone" data-rule="required" class="form-control" name="row[contact_phone]" type="text" value="{$row.contact_phone|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Email')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-email" data-rule="required" class="form-control" name="row[email]" type="text" value="{$row.email|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('City')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class='control-relative'><input id="c-city" class="form-control" data-toggle="city-picker" name="row[city]" type="text" value="{$row.city|htmlentities}"></div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-address" data-rule="required" class="form-control" name="row[address]" type="text" value="{$row.address|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('License_image')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-license_image" class="form-control" size="50" name="row[license_image]" type="text" value="{$row.license_image|htmlentities}">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-license_image" class="btn btn-danger faupload" data-input-id="c-license_image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-license_image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-license_image" class="btn btn-primary fachoose" data-input-id="c-license_image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-license_image"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-license_image"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="statusList" item="vo"}
            <label for="row[status]-{$key}"><input id="row[status]-{$key}" name="row[status]" type="radio" value="{$key}" {in name="key" value="$row.status"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Note')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-note" class="form-control " rows="5" name="row[note]" cols="50">{$row.note|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
